Outline

Objective

Thoracic outlet syndrome (TOS) consists of multifarious symptoms that are vague. The only typical thing about TOS is: it is usually atypical. A straight-forward surgical approach to treat TOS is indicated when a morphological correlate is present. During the routine diagnostic work-up of TOS, we found two patients with space-occupying lesions of the axilla. We present the cases here.

Methods

Case 1: A 51-year-old male presented himself to his family physician due to left-sided shoulder pain radiating through his arm and numbness in his forearm and all his fingers, especially during over head work. The condition had worsened over several months. Our exmination revealed all provocative signs of TOS. In addition there was a round, hard, mobile palpable mass in the axilla, about the size of an egg. MRI predicted the possibility of a lipoma. Surgical treatment was implemented.

Case 2: A 20-year-old girl with a known history of Recklinghausen's disease presented in our outpatient clinic with progressive pain and weakness in her left forearm. Neurological exacerbation of symptoms was noticed on provocative tests. Loss of sensation was reported along the ulnar border of the forearm. A hard and mobile mass was palpated in the left axilla. The palpation was extremely painful. MRI studies showed a large neurofibroma of the brachial plexus. Surgery was undertaken. Histology confirmed the tumor-type.

Surgical Approach and Results

A straightforward transaxillary surgical approach was undertaken in both the patients, since this was the direct and nearest corridor to the lesions. Both tumors were extirpated in toto. Pain and provocative signs disappeared immediately after surgery. No neurological symptoms were re-encountered in case 1 (16 months). Case 2 reported of paresthesias in her little finger after surgery. Muscle strength recovered only after rehabilitation. At a follow-up conducted 9 months after surgery, the patient still reported the occasional annoying paresthesias, to which she has adapted herself. There was no tumor recurrence in MRI. Both patients returned to their original professions.

Conclusions

Tumors of the axilla are generally uncommon. Those among them causing neurological symptoms are still rarer. In such cases the attention of the neurological surgeon is called for. Surgical extirpation is not complicated and seems logical in those cases.